01 | Evaluation of outcomes in syncope patients discharged from the emergency department of Piacenza: a retrospective monocentric study

Background. Syncope accounts for approximately 1-3% of visits to the Emergency Department (ED). In most instances it stems from a benign cause; however, rarely, it may indicate a serious and potentially fatal condition. Therefore, it is crucial to accurately assess patients who present to the ED with syncope. In our ED, the management of syncope follows a standardized approach based on the 2018 guidelines from the European Society of Cardiology.

Methods. This is a single-center, retrospective observational study approved by the AVEN Ethics Committee of the Emilia Nord Area. It includes all patients aged ≥18 years who presented to the ED for syncope between January 1, 2022, and December 31, 2024, and were discharged home. The study aims to verify whether the management of these cases aligns with current guidelines. The inclusion criteria are death or hospitalization within 30 days of discharge due to a cause related to syncope.

Results. A total of 45 patients were enrolled in the study (22 women and 23 men) with an average age of 77 years (69±29). During the three-year period from 2022 to 2024, there were 184,121 visits to the ED, of which 6,209 (3.3%) were due to syncope. Most patients, 4,546 (73%), were discharged from the ED; 25% of these discharges occurring after a period of observation in the ED/Observation Unit. In the 30 days following their discharge, there were 14 deaths and 31 hospitalizations, resulting in a total of 45 adverse events out of the 4,546 patients discharged (0.98%). Among the hospitalized patients, cardiac conditions were the most common diagnosis (19 out of 31), followed by gastrointestinal haemorrhage (3 out of 31) and pulmonary embolism (2 out of 31). In the remaining cases (7 out of 31), no pathological findings were identified during hospitalization, with the final diagnoses being "vasovagal syncope" or "orthostatic hypotension." Of the 14 patients who died, only 3 cases were potentially attributable to syncope.

Conclusions. Our operational guidelines facilitate the effective management of patients experiencing syncope, minimizing the risk of serious or fatal consequences.